Biological Pathways of Acute and Chronic Stress in Aged Hip Fracture Caregivers

老年髋部骨折护理人员急性和慢性应激的生物途径

• 批准号: 8068244
• 负责人: Lisa Fredman
• 金额: $ 60.79万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8068244
• 关键词: Acute; Address; Adult; Adverse effects; Affect; Alzheimer' s Disease; Anti-Inflammatory Agents; Anti-inflammatory; Area; Attention; Baltimore; Biological; Biological Markers; Biological Markers; Biological Process; Blood; Blood Pressure; Caregiver Burden; Caregivers; Caring; Catecholamines; Categories; Cessation of life; Cholesterol; Chronic; Chronic stress; Cognitive; Communities; Data; Development; Disease; Elderly; Epidemiologic Studies; Epinephrine; Event; Female; Fracture; Future; Glucose; Health; Hip Fractures; Hip region structure; Home environment; Hospitalization; Hospitals; Hour; Hydrocortisone; Immune; Immune system; Impaired cognition; Impairment; Incidence; Inflammatory; Inorganic Sulfates; Interleukin-10; Interleukin-6; Intervention; Interview; Interviewer; Lead; Link; Measures; Mental Depression; Mental Health; Metabolic syndrome; Modeling; Morbidity - disease rate; Neurosecretory Systems; Norepinephrine; Nurses; Outcome; Pathway interactions; Patient Self-Report; Patients; Performance; Persons; Physical Function; Physical activity; Physiological; Physiological Processes; Process; Prospective Studies; Recovery; Recruitment Activity; Research; Respondent; Risk Factors; Role; Sampling; Serum; Short-Term Memory; Social Network; Social support; Speed; Stress; Stress Fractures; Supervision; System; TNF gene; Testing; Theoretical model; Time; Training; Tumor Necrosis Factor-alpha; Unspecified or Sulfate Ion Sulfates; Urine; Walking; acute stress; aged; base; caregiving; cognitive function; cohort; depressive symptoms; executive function; experience; functional status; improved; inflammatory marker; instrumental activity of daily living; mortality; physical conditioning; psychosocial; stressor; theories; therapy design

DESCRIPTION (provided by applicant): It is known that acute and chronic stress have adverse effects on physical and cognitive functioning, but the mechanisms by which caregiving-related stress affects these outcomes remain unclear. The proposed study will evaluate the biological processes that may link acute and chronic caregiving stress to functional and cognitive outcomes. It tests the theory that stress disrupts multiple, interrelated homeostatic systems (HPA axis, neuroendocrine, and immune systems), which may lead to metabolic syndrome and subsequent health decline. The sample will include 225 older informal caregivers to elderly hip fracture patients recruited from 8 Baltimore area hospitals (108 new and continuing caregivers to patients in the Baltimore Hip Studies, BHS-7; and 117 new and continuing caregivers to female patients from these hospitals who were not recruited to the BHS-7 study). Caregivers will be identified by patients prior to discharge in order to maximize the number of new caregivers, and to obtain baseline data during a time of acute stress. Four (4) annual home-based interviews will be conducted by trained nurse interviewers. At each interview, blood pressure, anthropomorphic measures, and biological markers will be obtained (24-hour urine for catecholamines and cortisol, serum for DHEAS, pro- and anti-inflammatory markers, glucose, cholesterol). Blood will be stored for future analyses. Interview data include caregiving-related stressors, physical health and activity, depressive symptoms, and other potential confounders and effect modifiers. Functional status will be based on walking speed, chair stands and self-reported ADLs/IADLs. Cognitive measures include tests of executive functioning, speed/attention, working memory, and category fluency. Hypotheses will address: 1) sequential pathways from caregiving stress, to physiological changes, metabolic syndrome, and functional and cognitive outomes; 2) comparisons of the effects of acute and chronic caregiving stress, and end of caregiving due to the patient's recovery; and 3) mechanisms by which modifiers (ie, social support caregiving factors) affect these pathways. Mixed effects models will be used to examine the temporal associations from caregiver stress to biological changes, to functional and cognitive outcomes, and the effects of time-varying covariates (i.e., cessation of caregiving). Results will advance research on physiological and health effects of acute and chronic caregiving stress, and have implications for interventions for caregivers to adults with hip fracture or other conditions. PUBLIC HEALTH RELEVANCE Caregivers experience high rates of stress, but little is known about the physiological mechanisms by which caregiving-related stress leads to adverse health outcomes. The proposed study will address this question in 225 older caregivers to hip fracture patients; this group has received little attention, but is ideal for studying the effects of acute and chronic caregiving stress and cessation of caregiving since hip fracture is an acute event, and 50% of the patients recover within a year of their fracture. We will evaluate the biological processes that may link caregiving stress to the development of metabolic syndrome, and subsequent decline in functional and cognitive status. The results will advance research on the physiological and health effects of caregiving, and have implications for designing interventions for caregivers to persons with hip fracture or other conditions.

描述（由申请人提供）： 众所周知，急性和慢性应激对身体和认知功能具有不利影响，但是与护理相关的压力影响这些结果的机制尚不清楚。拟议的研究将评估可能将急性和慢性护理应力与功能和认知结果联系起来的生物学过程。它测试了应力破坏多个相互关联的稳态系统（HPA轴，神经内分泌和免疫系统）的理论，该系统可能导致代谢综合征以及随后的健康状况下降。该样本将包括225名从巴尔的摩地区医院招募的老年髋部骨折患者（巴尔的摩髋关节研究中的患者，有108名新的和持续的护理人员，BHS-7的患者，BHS-7； 117名新的和持续的护理人员向未招募BHS-7研究的这些医院的患者）。出院前，患者将确定护理人员，以最大程度地提高新护理人员的数量，并在急性压力期间获得基线数据。训练有素的护士面试官将进行四（4）个年度家庭访谈。在每次访谈中，将获得血压，拟人化测量和生物学标记（儿茶酚胺和皮质醇的24小时尿液，DHEAS，促疾病和抗炎标记，葡萄糖，胆固醇的血清）。血液将存储以进行将来的分析。访谈数据包括与护理相关的压力源，身体健康和活动，抑郁症状以及其他潜在的混杂因素以及效果修饰符。功能状态将基于步行速度，椅子支架和自我报告的ADL/IADL。认知措施包括执行功能，速度/注意力，工作记忆和类别流利度的测试。假设将解决：1）从护理应力到生理变化，代谢综合征以及功能和认知异构体的顺序途径； 2）比较急性和慢性护理压力的影响，以及由于患者康复而导致的护理结束； 3）修饰符（即社会支持护理因素）影响这些途径的机制。混合效应模型将用于检查从照顾者应力到生物学变化，功能和认知结果的时间关联，以及随时间变化的协变量的影响（即护理人员的停止）。结果将提高对急性和慢性护理压力的生理和健康影响的研究，并对护理人员对患有髋部骨折或其他状况的成年人的干预措施产生影响。公共卫生相关性护理人员经历了很高的压力率，但对与护理相关的压力导致不良健康结果的生理机制知之甚少。拟议的研究将在225名年长的护理人员中解决这个问题，以解决髋部骨折患者；该小组几乎没有受到关注，但非常适合研究急性和慢性护理应力的影响以及护理的停止，因为髋部骨折是急性事件，而50％的患者在骨折的一年内康复。我们将评估可能将护理压力与代谢综合征发展以及随后功能和认知状况下降的生物学过程。结果将提高对护理的生理和健康影响的研究，并对为患有髋部骨折或其他疾病的人设计干预措施具有影响。